Esophageal Microbiome, Epithelial Gene Expression, and Response to Topical Swallowed Steroids in Pediatric Eosinophilic Esophagitis

总结 嗜酸性粒细胞性食管炎（EoE）是一种越来越普遍的过敏原介导的临床病理 条件其特征在于存在食管症状和食管功能受损。 嗜酸性粒细胞性炎症中的上皮屏障。患有EoE的儿童患有 使人衰弱的症状，如呕吐、进食困难、无法吞咽和发育不良。 局部吞咽类固醇（TSS）是EoE治疗的支柱，可以改善 症状、组织学缓解和上皮屏障功能的恢复。然而，超过50%的 患有EoE的儿童可能对TSS没有反应，并继续遭受持续的症状， 对他们的生活质量产生负面影响。此外，不受控制的嗜酸性粒细胞炎症可进一步 损害食管上皮特性并导致上皮下纤维化， 需要紧急内镜检查或手术的食管狭窄和食管食物嵌塞 干预到目前为止，对儿童TSS反应的相关因素知之甚少 关于EoE特别是，食管微生物组的作用及其如何与食管 尚未研究EoE儿童中上皮细胞对TSS反应的影响。重要的是要 我理解这种关系，因为EoE的发病率和患病率迅速增加， 表明环境因素如食管微生物组可能在 调节EoE中的治疗反应。本申请的目的是研究 食管微生物组及其与TSS应答者（EoE-TSSr）中宿主上皮的串扰， TSS无应答者（EoE-TSSnr）和非EoE对照。这是第一次，它将决定 TSS治疗结果部分由驻留食管微生物群结构和功能得出， 可能会改变食管屏障的完整性和免疫功能。使用儿童EoE队列- TSSr、EoE-TSSnr和非EoE对照，我们将： 食管组织样品中物种水平的功能能力，B）确定 活跃食管微生物组、宿主上皮表达谱和TSS之间的关联 治疗效果本研究的结果将扩大我们对影响因素的理解 与儿童EoE对TSS的反应有关。从长远来看，这项研究将为 个性化的儿科EOE护理。

Summary Eosinophilic esophagitis (EoE) is an increasingly prevalent allergen-mediated clinico-pathologic condition. It is characterized by the presence of esophageal symptoms and impaired esophageal epithelial barrier in the setting of eosinophilic inflammation. The children with EoE suffer from debilitating symptoms such as vomiting, feeding difficulties, inability to swallow, and failure to thrive. Topical swallowed steroids (TSS) are the mainstay of EoE therapy and can lead to improvement in symptoms, histologic remission, and restoration of the epithelial barrier function. However, over 50% of children with EoE may not respond to TSS and continue to suffer from unremitting symptoms which can negatively impact their quality of life. Additionally, the uncontrolled eosinophilic inflammation can further compromise the esophageal epithelial properties and lead to sub-epithelial fibrosis resulting in esophageal stricture and esophageal food impactions requiring emergent endoscopy or surgical intervention. To date, very little is known about the factors associated with response to TSS in children with EoE. In particular, the role of esophageal microbiome and how it interacts with the esophageal epithelium to impact the response to TSS in children with EoE has not been studied. It is important to understand this relationship as the rapid increase in the incidence and prevalence of EoE strongly indicates that environmental factors such as esophageal microbiome may have an essential role in modulating the treatment response in EoE. The objective of this application is to investigate the role of the esophageal microbiome and its cross-talk with the host epithelium in TSS responders (EoE-TSSr), TSS non-responders (EoE-TSSnr) and non-EoE controls. For the first time, it would determine whether TSS therapy outcomes are derived in part by resident esophagus microbiota structure and function that can potentially alter esophageal barrier integrity and immune function. Using a pediatric cohort of EoE- TSSr, EoE-TSSnr and non-EoE controls we will: a) characterize the microbiome composition and functional capability at the species level in the esophagus tissue samples, b) determine the mechanistic association between active esophagus microbiome, host epithelium expression profiles, and TSS therapy efficacy. The outcomes of this study will expand our understanding about the factors associated with response to TSS in pediatric EoE. In the long term, this study will lay the foundation for personalizing the care in pediatric EoE.